Yes, we still need chickenpox vaccines
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For people who grew up before a vaccine was available, chickenpox is largely remembered as an unpleasant experience that almost every child suffered through. The highly contagious disease tore through communities, leaving behind more than a few lasting scars.
For many children, chickenpox was much more than a week or two of itchy discomfort. It was a serious and sometimes life-threatening infection.
Prior to the chickenpox vaccine’s introduction in 1995, 90 percent of children got chickenpox. Those children grew into adults with an increased risk of developing shingles, a disease caused by the same virus—varicella-zoster—as chickenpox, which lies dormant in the body for decades.
The vaccine changed all that, nearly wiping out chickenpox in the U.S. in under three decades. The vaccine has been so successful that some people falsely believe the disease no longer exists and that vaccination is unnecessary. This couldn’t be further from the truth.
Vaccination spares children and adults from the misery of chickenpox and the serious short- and long-term risks associated with the disease. The CDC estimates that 93 percent of children in the U.S. are fully vaccinated against chickenpox. However, outbreaks can still occur among unvaccinated and under-vaccinated populations.
Here are some of the many reasons why we still need chickenpox vaccines.
Chickenpox is more serious than you may remember
For most children, chickenpox lasts around a week. Symptoms vary in severity but typically include a rash of small, itchy blisters that scab over, fever, fatigue, and headache.
However, in one out of every 4,000 chickenpox cases, the virus infects the brain, causing swelling. If the varicella-zoster virus makes it to the part of the brain that controls balance and muscle movements, it can cause a temporary loss of muscle control in the limbs that can last for months. Chickenpox can also cause other serious complications, including skin, lung, and blood infections.
Prior to the U.S.’ approval of the vaccine in 1995, children accounted for most of the country’s chickenpox cases, with over 10,000 U.S. children hospitalized with chickenpox each year.
The chickenpox vaccine is very effective and safe
Chickenpox is an extremely contagious disease. People without immunity have a 90 percent chance of contracting the virus if exposed.
Fortunately, the chickenpox vaccine provides lifetime protection and is around 90 percent effective against infection and nearly 100 percent effective against severe illness. It also reduces the risk of developing shingles later in life.
In addition to being incredibly effective, the chickenpox vaccine is very safe, and serious side effects are extremely rare. Some people may experience mild side effects after vaccination, such as pain at the injection site and a low fever.
Although infection provides immunity against future chickenpox infections, letting children catch chickenpox to build up immunity is never worth the risk, especially when a safe vaccine is available. The purpose of vaccination is to gain immunity without serious risk.
The chickenpox vaccine is one of the greatest vaccine success stories in history
It’s difficult to overstate the impact of the chickenpox vaccine. Within five years of the U.S. beginning universal vaccination against chickenpox, the disease had declined by over 80 percent in some regions.
Nearly 30 years after the introduction of the chickenpox vaccine, the disease is almost completely wiped out. Cases and hospitalizations have plummeted by 97 percent, and chickenpox deaths among people under 20 are essentially nonexistent.
Thanks to the vaccine, in less than a generation, a disease that once swept through schools and affected nearly every child has been nearly eliminated. And, unlike vaccines introduced in the early 20th century, no one can argue that improved hygiene, sanitation, and health helped reduce chickenpox cases beginning in the 1990s.
Having chickenpox as a child puts you at risk of shingles later
Although most people recover from chickenpox within a week or two, the virus that causes the disease, varicella-zoster, remains dormant in the body. This latent virus can reactivate years after the original infection as shingles, a tingling or burning rash that can cause severe pain and nerve damage.
One in 10 people who have chickenpox will develop shingles later in life. The risk increases as people get older as well as for those with weakened immune systems.
Getting chickenpox as an adult can be deadly
Although chickenpox is generally considered a childhood disease, it can affect unvaccinated people of any age. In fact, adult chickenpox is far deadlier than pediatric cases.
Serious complications like pneumonia and brain swelling are more common in adults than in children with chickenpox. One in 400 adults who get chickenpox develops pneumonia, and one to two out of 1,000 develop brain swelling.
Vaccines have virtually eliminated chickenpox, but outbreaks still happen
Although the chickenpox vaccine has dramatically reduced the impact of a once widespread disease, declining immunity could lead to future outbreaks. A Centers for Disease Control and Prevention analysis found that chickenpox vaccination rates dropped in half of U.S. states in the 2022-2023 school year compared to the previous year. And more than a dozen states have immunization rates below 90 percent.
In 2024, New York City and Florida had chickenpox outbreaks that primarily affected unvaccinated and under-vaccinated children. With declining public confidence in routine vaccines and rising school vaccine exemption rates, these types of outbreaks will likely become more common.
The CDC recommends that children receive two chickenpox vaccine doses before age 6. Older children and adults who are unvaccinated and have never had chickenpox should also receive two doses of the vaccine.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and
not to mention butwe’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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What is AuDHD? 5 important things to know when someone has both autism and ADHD
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You may have seen some new ways to describe when someone is autistic and also has attention-deficit hyperactivity disorder (ADHD). The terms “AuDHD” or sometimes “AutiADHD” are being used on social media, with people describing what they experience or have seen as clinicians.
It might seem surprising these two conditions can co-occur, as some traits appear to be almost opposite. For example, autistic folks usually have fixed routines and prefer things to stay the same, whereas people with ADHD usually get bored with routines and like spontaneity and novelty.
But these two conditions frequently overlap and the combination of diagnoses can result in some unique needs. Here are five important things to know about AuDHD.
Kosro/Shutterstock 1. Having both wasn’t possible a decade ago
Only in the past decade have autism and ADHD been able to be diagnosed together. Until 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the reference used by health workers around the world for definitions of psychological diagnoses – did not allow for ADHD to be diagnosed in an autistic person.
The manual’s fifth edition was the first to allow for both diagnoses in the same person. So, folks diagnosed and treated prior to 2013, as well as much of the research, usually did not consider AuDHD. Instead, children and adults may have been “assigned” to whichever condition seemed most prominent or to be having the greater impact on everyday life.
2. AuDHD is more common than you might think
Around 1% to 4% of the population are autistic.
They can find it difficult to navigate social situations and relationships, prefer consistent routines, find changes overwhelming and repetition soothing. They may have particular sensory sensitivities.
ADHD occurs in around 5–8% of children and adolescents and 2–6% of adults. Characteristics can include difficulties with focusing attention in a flexible way, resulting in procrastination, distraction and disorganisation. People with ADHD can have high levels of activity and impulsivity.
Studies suggest around 40% of those with ADHD also meet diagnostic criteria for autism and vice versa. The co-occurrence of having features or traits of one condition (but not meeting the full diagnostic criteria) when you have the other, is even more common and may be closer to around 80%. So a substantial proportion of those with autism or ADHD who don’t meet full criteria for the other condition, will likely have some traits.
3. Opposing traits can be distressing
Autistic people generally prefer order, while ADHDers often struggle to keep things organised. Autistic people usually prefer to do one thing at a time; people with ADHD are often multitasking and have many things on the go. When someone has both conditions, the conflicting traits can result in an internal struggle.
For example, it can be upsetting when you need your things organised in a particular way but ADHD traits result in difficulty consistently doing this. There can be periods of being organised (when autistic traits lead) followed by periods of disorganisation (when ADHD traits dominate) and feelings of distress at not being able to maintain organisation.
There can be eventual boredom with the same routines or activities, but upset and anxiety when attempting to transition to something new.
Autistic special interests (which are often all-consuming, longstanding and prioritised over social contact), may not last as long in AuDHD, or be more like those seen in ADHD (an intense deep dive into a new interest that can quickly burn out).
Autism can result in quickly being overstimulated by sensory input from the environment such as noises, lighting and smells. ADHD is linked with an understimulated brain, where intense pressure, novelty and excitement can be needed to function optimally.
For some people the conflicting traits may result in a balance where people can find a middle ground (for example, their house appears tidy but the cupboards are a little bit messy).
There isn’t much research yet into the lived experience of this “trait conflict” in AuDHD, but there are clinical observations.
4. Mental health and other difficulties are more frequent
Our research on mental health in children with autism, ADHD or AuDHD shows children with AuDHD have higher levels of mental health difficulites than autism or ADHD alone.
This is a consistent finding with studies showing higher mental health difficulties such as depression and anxiety in AuDHD. There are also more difficulties with day-to-day functioning in AuDHD than either condition alone.
So there is an additive effect in AuDHD of having the executive foundation difficulties found in both autism and ADHD. These difficulties relate to how we plan and organise, pay attention and control impulses. When we struggle with these it can greatly impact daily life.
5. Getting the right treatment is important
ADHD medication treatments are evidence-based and effective. Studies suggest medication treatment for ADHD in autistic people similarly helps improve ADHD symptoms. But ADHD medications won’t reduce autistic traits and other support may be needed.
Non-pharmacological treatments such as psychological or occupational therapy are less researched in AuDHD but likely to be helpful. Evidence-based treatments include psychoeducation and psychological therapy. This might include understanding one’s strengths, how traits can impact the person, and learning what support and adjustments are needed to help them function at their best. Parents and carers also need support.
The combination and order of support will likely depend on the person’s current functioning and particular needs. https://www.youtube.com/embed/pMx1DnSn-eg?wmode=transparent&start=0 ‘Up until recently … if you had one, you couldn’t have the other.’
Do you relate?
Studies suggest people may still not be identified with both conditions when they co-occur. A person in that situation might feel misunderstood or that they can’t fully relate to others with a singular autism and ADHD diagnosis and something else is going on for them.
It is important if you have autism or ADHD that the other is considered, so the right support can be provided.
If only one piece of the puzzle is known, the person will likely have unexplained difficulties despite treatment. If you have autism or ADHD and are unsure if you might have AuDHD consider discussing this with your health professional.
Tamara May, Psychologist and Research Associate in the Department of Paediatrics, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Passion Fruit vs Persimmon – Which is Healthier?
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Our Verdict
When comparing passion fruit to persimmon, we picked the passion fruit.
Why?
You may be wondering: “what is this fruit passionate about?” and the answer is: delivering nutrients of many kinds!
Looking at the macros first, passion fruit has a little more protein and a lot more fiber, while persimmon has more carbs. This means that while persimmon’s glycemic index isn’t bad, passion fruit’s glycemic index is a lot lower.
In terms of vitamins, passion fruit has a lot more of vitamins A, B2, B3, B6, B9, E, K, and choline, while persimmon has more vitamin C. For the record passion fruit is also a good source of vitamin C, with a cup of passion fruit already giving a day’s daily dose of vitamin C, but persimmon gives twice that. Still, that’s a 8:1 win for passion fruit.
When it comes to minerals, passion fruit has more copper, magnesium, phosphorus, potassium, selenium, and zinc, while persimmon has more calcium and iron, meaning a 6:2 win for passion fruit.
Adding up the three convincing individual victories shows a clear overall win for passion fruit.
Enjoy (passionately, even)!
Want to learn more?
You might like to read:
- Glycemic Index vs Glycemic Load vs Insulin Index
- Which Sugars Are Healthier, And Which Are Just The Same?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
Take care!
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Hope: A research-based explainer
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This year, more than 60 countries, representing more than 4 billion people, will hold major elections. News headlines already are reporting that voters are hanging on to hope. When things get tough or don’t go our way, we’re told to hang on to hope. HOPE was the only word printed on President Barack Obama’s iconic campaign poster in 2008.
Research on hope has flourished only in recent decades. There’s now a growing recognition that hope has a role in physical, social, and mental health outcomes, including promoting resilience. As we embark on a challenging year of news, it’s important for journalists to learn about hope.
So what is hope? And what does the research say about it?
Merriam-Webster defines hope as a “desire accompanied by expectation of or belief in fulfillment.” This definition highlights the two basic dimensions of hope: a desire and a belief in the possibility of attaining that desire.
Hope is not Pollyannaish optimism, writes psychologist Everett Worthington in a 2020 article for The Conversation. “Instead, hope is a motivation to persevere toward a goal or end state, even if we’re skeptical that a positive outcome is likely.”
There are several scientific theories about hope.
One of the first, and most well-known, theories on hope was introduced in 1991 by American psychologist Charles R. Snyder.
In a paper published in the Journal of Personality and Social Psychology, Snyder defined hope as a cognitive trait centered on the pursuit of goals and built on two components: a sense of agency in achieving a goal, and a perceived ability to create pathways to achieve that goal. He defined hope as something individualistic.
Snyder also introduced the Hope Scale, which continues to be used today, as a way to measure hope. He suggested that some people have higher levels of hope than others and there seem to be benefits to being more hopeful.
“For example, we would expect that higher as compared with lower hope people are more likely to have a healthy lifestyle, to avoid life crises, and to cope better with stressors when they are encountered,” they write.
Others have suggested broader definitions.
In 1992, Kaye Herth, a professor of nursing and a scholar on hope, defined hope as “a multidimensional dynamic life force characterized by a confident yet uncertain expectation of achieving good, which to the hoping person, is realistically possible and personally significant.” Herth also developed the Herth Hope Index, which is used in various settings, including clinical practice and research.
More recently, others have offered an even broader definition of hope.
Anthony Scioli, a clinical psychologist and author of several books on hope, defines hope “as an emotion with spiritual dimensions,” in a 2023 review published in Current Opinion in Psychology. “Hope is best viewed as an ameliorating emotion, designed to fill the liminal space between need and reality.”
Hope is also nuanced.
“Our hopes may be active or passive, patient or critical, private or collective, grounded in the evidence or resolute in spite of it, socially conservative or socially transformative,” writes Darren Webb in a 2007 study published in History of the Human Sciences. “We all hope, but we experience this most human of all mental feelings in a variety of modes.”
To be sure, a few studies have shown that hope can have negative outcomes in certain populations and situations. For example, one study highlighted in the research roundup below finds that Black college students who had higher levels of hope experienced more stress due to racial discrimination compared with Black students who had lower levels of hope.
Today, hope is one of the most well-studied constructs within the field of positive psychology, according to the journal Current Opinion in Psychology, which dedicated its August 2023 issue to the subject. (Positive psychology is a branch of psychology focused on characters and behaviors that allow people to flourish.)
We’ve gathered several studies below to help you think more deeply about hope and recognize its role in your everyday lives.
Research roundup
The Role of Hope in Subsequent Health and Well-Being For Older Adults: An Outcome-Wide Longitudinal Approach
Katelyn N.G. Long, et al. Global Epidemiology, November 2020.The study: To explore the potential public health implications of hope, researchers examine the relationship between hope and physical, behavioral and psychosocial outcomes in 12,998 older adults in the U.S. with a mean age of 66.
Researchers note that most investigations on hope have focused on psychological and social well-being outcomes and less attention has been paid to its impact on physical and behavioral health, particularly among older adults.
The findings: Results show a positive association between an increased sense of hope and a variety of behavioral and psychosocial outcomes, such as fewer sleep problems, more physical activity, optimism and satisfaction with life. However, there wasn’t a clear association between hope and all physical health outcomes. For instance, hope was associated with a reduced number of chronic conditions, but not with stroke, diabetes and hypertension.
The takeaway: “The later stages of life are often defined by loss: the loss of health, loved ones, social support networks, independence, and (eventually) loss of life itself,” the authors write. “Our results suggest that standard public health promotion activities, which often focus solely on physical health, might be expanded to include a wider range of factors that may lead to gains in hope. For example, alongside community-based health and nutrition programs aimed at reducing chronic conditions like hypertension, programs that help strengthen marital relations (e.g., closeness with a spouse), provide opportunities to volunteer, help lower anxiety, or increase connection with friends may potentially increase levels of hope, which in turn, may improve levels of health and well-being in a variety of domains.”
Associated Factors of Hope in Cancer Patients During Treatment: A Systematic Literature Review
Corine Nierop-van Baalen, Maria Grypdonck, Ann van Hecke and Sofie Verhaeghe. Journal of Advanced Nursing, March 2020.The study: The authors review 33 studies, written in English or Dutch and published in the past decade, on the relationship between hope and the quality of life and well-being of patients with cancer. Studies have shown that many cancer patients respond to their diagnosis by nurturing hope, while many health professionals feel uneasy when patients’ hopes go far beyond their prognosis, the authors write.
The findings: Quality of life, social support and spiritual well-being were positively associated with hope, as measured with various scales. Whereas symptoms, psychological distress and depression had a negative association with hope. Hope didn’t seem to be affected by the type or stage of cancer or the patient’s demographics.
The takeaway: “Hope seems to be a process that is determined by a person’s inner being rather than influenced from the outside,” the authors write. “These factors are typically given meaning by the patients themselves. Social support, for example, is not about how many patients experience support, but that this support has real meaning for them.”
Characterizing Hope: An Interdisciplinary Overview of the Characteristics of Hope
Emma Pleeging, Job van Exel and Martijn Burger. Applied Research in Quality of Life, September 2021.The study: This systematic review provides an overview of the concept of hope based on 66 academic papers in ten academic fields, including economics and business studies, environmental studies, health studies, history, humanities, philosophy, political science, psychology, social science, theology and youth studies, resulting in seven themes and 41 sub-themes.
The findings: The authors boil down their findings to seven components: internal and external sources, the individual and social experience of hope, internal and external effects, and the object of hope, which can be “just about anything we can imagine,” the authors write.
The takeaway: “An important implication of these results lies in the way hope is measured in applied and scientific research,” researchers write. “When measuring hope or developing instruments to measure it, researchers could be well-advised to take note of the broader understanding of the topic, to prevent that important characteristics might be overlooked.”
Revisiting the Paradox of Hope: The Role of Discrimination Among First-Year Black College Students
Ryon C. McDermott, et al. Journal of Counseling Psychology, March 2020.The study: Researchers examine the moderating effects of hope on the association between experiencing racial discrimination, stress and academic well-being among 203 first-year U.S. Black college students. They build on a small body of evidence that suggests high levels of hope might have a negative effect on Black college students who experience racial discrimination.
The authors use data gathered as part of an annual paper-and-pencil survey of first-year college students at a university on the Gulf Coast, which the study doesn’t identify.
The findings: Researchers find that Black students who had higher levels of hope experienced more stress due to racial discrimination compared with students who had lower levels of hope. On the other hand, Black students with low levels of hope may be less likely to experience stress when they encounter discrimination.
Meanwhile, Black students who had high levels of hope were more successful in academic integration — which researchers define as satisfaction with and integration into the academic aspects of college life — despite facing discrimination. But low levels of hope had a negative impact on students’ academic well-being.
“The present study found evidence that a core construct in positive psychology, hope, may not always protect Black students from experiencing the psychological sting of discrimination, but it was still beneficial to their academic well-being,” the authors write.
The takeaway: “Our findings also highlight an urgent need to reduce discrimination on college campuses,” the researchers write. “Reducing discrimination could help Black students (and other racial minorities) avoid additional stress, as well as help them realize the full psychological and academic benefits of having high levels of hope.”
Additional reading
Hope Across Cultural Groups Lisa M. Edwards and Kat McConnell. Current Opinion in Psychology, February 2023.
The Psychology of Hope: A Diagnostic and Prescriptive Account Anthony Scioli. “Historical and Multidisciplinary Perspectives on Hope,” July 2020.
Hope Theory: Rainbows in the Mind C.R. Snyder. Psychological Inquiry, 2002
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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A Planet of Viruses – by Carl Zimmer
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We’ve reviewed numerous books on the immune system before, and this one’s mostly not about that.
Instead, this one focuses on the viruses themselves, and the part they play in our world, for good and for ill. Popular awareness tends to focus on the ill, of course.
But, there’s a lot that viruses do for us too, including:
- Weak/harmless viruses that keep our immune systems on their toes and ready
- Bacteriophage viruses that kill and consume pathogens that, left unchecked, would do the same to us
- Endogenous retroviruses that have become symbiotic with the human organism, without which our species would quickly go extinct
He also talks about biological warfare, and how we cannot bury our heads in the sand by avoiding research on those grounds, because someone will always do it anyway, so (as the motto of the immune system itself might say), best to be prepared.
The author is a science journalist, by the way, and has no PhD, but does have a flock of Fellowships and assorted scientific awards and honors, so he appears to be doing good work so far as the scientific community is concerned.
Bottom line: if you’d like to know more about viruses than “they’re very small and can cause harm”, then this book will open a whole new world.
Click here to check out A Planet of Viruses, and upgrade your knowledge!
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Bored of Lunch – by Nathan Anthony
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Cooking with a slow cooker is famously easy, but often we settle down on a few recipes and then don’t vary. This book brings a healthy dose of inspiration and variety.
The recipes themselves range from comfort food to fancy entertaining, pasta dishes to risottos, and even what the author categorizes as “fakeaways” (a play on the British English “takeaway”, cf. AmE “takeout”), so indulgent nights in have never been healthier!
For each recipe, you’ll see a nice simple clear layout of all you’d expect (ingredients, method, etc) plus calorie count, so that you can have a rough idea of how much food each meal is.
In terms of dietary restrictions you may have, there’s quite a variety here so it’ll be easy to find things for all needs, and in addition to that, optional substitutions are mostly quite straightforward too.
Bottom line: if you have a slow cooker but have been cooking only the same three things in it for the past ten years, this is the book to liven things up, while staying healthy!
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